Biomechanical Comparison of Arthroscopic Repair Constructs for Radial Tears of the Meniscus

Branch, Eric A.; Milchteim, Charles; Aspey, Bradley S.; Liu, Wei; Saliman, Justin D.; Anz, Adam W.

doi:10.1177/0363546515591994

Cited by 47 publications

(38 citation statements)

References 28 publications

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“…While the biomimetic scaffold mimicked the topography and tensile properties of native menisci, it did not improve the mechanical properties of a simulated radial meniscal tear repaired with suture. Both the ultimate failure load (~125 N) and stiffness (~19 N/mm) of the repair and scaffold-augmented groups are comparable to reported values using similar suture techniques in cadaveric models (Beamer et al 2015 ; Bhatia et al 2015 ; Branch et al 2015 ; Herbort et al 2010 ). In testing different suture techniques, Herbort et al ( 2010 ) and Branch et al ( 2015 ) confirmed that multiple sutures are superior to a single suture loop, providing in vitro support to the clinical standard of using an inside-out double horizontal suture technique for repair of radial tears.…”

Section: Discussionsupporting

confidence: 79%

“…Both the ultimate failure load (~125 N) and stiffness (~19 N/mm) of the repair and scaffold-augmented groups are comparable to reported values using similar suture techniques in cadaveric models (Beamer et al 2015 ; Bhatia et al 2015 ; Branch et al 2015 ; Herbort et al 2010 ). In testing different suture techniques, Herbort et al ( 2010 ) and Branch et al ( 2015 ) confirmed that multiple sutures are superior to a single suture loop, providing in vitro support to the clinical standard of using an inside-out double horizontal suture technique for repair of radial tears. In this study, a single horizontal stitch was placed equidistant from the central and peripheral rims to reduce the torn edges before performing a double horizontal mattress suture repair, with or without inclusion of the biomimetic scaffold serving as a sheath.…”

Section: Discussionsupporting

confidence: 79%

“…In a canine model, Newman et al ( 1989 ) found that “healed” radial tear defects consisted of a 3–5 mm gap of fibrovascular scar that failed to restore normal tissue mechanics. As a result, numerous surgical techniques have been explored in an effort to improve repair strength and maintain apposition of the torn edges (Beamer et al 2015 ; Branch et al 2015 ; Herbort et al 2010 ; Lee et al 2012 ; Matsubara et al 2012 ). Similarly, though largely unexplored in regards to meniscal tears, scaffold sheets can minimize gap formation and augment mechanical properties of surgical repairs of musculoskeletal tissues (McCarron et al 2010 , 2012 ).…”

Section: Introductionmentioning

confidence: 99%

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Augmented repair of radial meniscus tear with biomimetic electrospun scaffold: an in vitro mechanical analysis

et al. 2016

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BackgroundLarge radial tears that disrupt the circumferential fibers of the meniscus are associated with reduced meniscal function and increased risk of joint degeneration. Electrospun fibrous scaffolds can mimic the topography and mechanics of fibrocartilaginous tissues and simultaneously serve as carriers of cells and growth factors, yet their incorporation into clinically relevant suture repair techniques for radial meniscus tears is unexplored. The purposes of this study were to (1) evaluate the effect of fiber orientation on the tensile properties and suture-retention strength of multilayered electrospun scaffolds and (2) determine the mechanical effects of scaffold inclusion within a surgical repair of a simulated radial meniscal tear. The experimental hypothesis was that augmentation with a multilayered scaffold would not compromise the strength of the repair.MethodsThree multilayered electrospun scaffolds with different fiber orientations were fabricated–aligned, random, and biomimetic. The biomimetic scaffold was comprised of four layers in the following order (deep to superficial)–aligned longitudinal, aligned transverse, aligned longitudinal, and random–respectively corresponding to circumferential, radial, circumferential, and superficial collagen fibers of the native meniscus. Material properties (i.e., ultimate stress, modulus, etc.) of the scaffolds were determined in the parallel and perpendicular directions, as was suture retention strength. Complete radial tears of lateral bovine meniscus explants were repaired with a double horizontal mattress suture technique, with or without inclusion of the biomimetic scaffold sheath. Both repair groups, as well as native controls, were cyclically loaded between 5 and 20 N for 500 cycles and then loaded to failure. Clamp-to-clamp distance (i.e., residual elongation) was measured following various cycles. Ultimate load, ultimate elongation, and stiffness, were also determined. Group differences were evaluated by one-way ANOVA or Student’s t-test where appropriate.ResultsAligned scaffolds possessed the most anisotropic mechanical properties, whereas random scaffolds showed uniform properties in the parallel and perpendicular directions. In comparison, the biomimetic scaffold possessed moduli in the parallel (68.7 ± 14.7 MPa) and perpendicular (39.4 ± 11.6 MPa) directions that respectively approximate the reported circumferential and radial tensile properties of native menisci. The ultimate suture retention load of the biomimetic scaffold in the parallel direction (7.2 ± 1.6 N) was significantly higher than all other conditions (p < 0.001). Biomimetic scaffold augmentation did not compromise mechanical properties when compared against suture repair in terms of residual elongation after 500 cycles (scaffold: 5.05 ± 0.89 mm vs. repair: 4.78 ± 1.24 mm), ultimate failure load (137.1 ± 31.0 N vs. 124.4 ± 21.4 N), ultimate elongation (12.09 ± 5.89 mm vs. 10.14 ± 4.61 mm), and stiffness (20.8 ± 3.6 vs. 18.4 ± 4.7 N/mm).ConclusionsWhile multilayered scaffold sheets wer...

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

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Augmented repair of radial meniscus tear with biomimetic electrospun scaffold: an in vitro mechanical analysis

et al. 2016

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“…Some sports have a higher prevalence of ACL injuries and others have prevalence of meniscal injuries. Few studies correlate ligament and meniscus injury to the sport practiced 11, 12, 13, 14…”

Section: Introductionmentioning

confidence: 99%

Anterior cruciate ligament and meniscal injuries in sports: incidence, time of practice until injury, and limitations caused after trauma

Astur

Xerez

Rozas

et al. 2016

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveTo analyze the incidence of ACL and meniscal injuries in a population of recreational and elite athletes from Brazil and the relation of these injuries with their sports activities.MethodsThis was a prospective observational study of 240 patients with ACL and/or meniscal injuries submitted to surgical treatment. Data of patients and sport modality, as well as Tegner score were registered in the first clinical evaluation. The patients were divided into three groups: (1) isolated rupture of the ACL; (2) ACL injury associated with meniscal injury; (3) isolated menisci injury.ResultsThe majority of the patients belonged to group 1 (44.58%), followed by group 2 (30.2%) and 3 (25%). Most patients were soccer players. The mean time from sport practice to injury in group 1 was 17.81 years. In group 2, it was 17.3 years, and in group 3, 26.91 years. Soccer athletes presented ACL injury in 0.523/1000 h of practice and meniscal injury in 0.448/1000 h of practice. Before the injury, the mean Tegner score obtained for groups 1, 2, and 3 were 7.18, 7.34, and 6.53, respectively. After knee injury, those values were 3.07, 3.18, and 2.87, respectively.ConclusionSoccer was the sport that caused the majority of lesions, regardless the group. Furthermore, patients from groups 1 and 2 had less time of practice prior to the injury (17.81 and 17.3 years) than the patients of group 3 (26.91 years). Women presented a higher risk to develop ACL and meniscal injuries in 1000 h of game/practice. Running, volleyball, and weightlifting are in ascending order of risk for ACL and/or meniscal injury. Regarding the return to sport practice, the efficiency of all athletes was impaired because of the injury.

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“…The biomechanical consequences of near full thickness radial tears that violate the circumferential band result in substantial changes in joint loading. 6,7 The authors conclude that clinical success can be achieved by properly indicated radial tear repairs. Can we do better?…”

Section: See Related Article On Page 1919mentioning

confidence: 91%

Editorial Commentary: Stay Tuned: Broadening Our Scope of Knee Meniscus Radial Tear Repairs

Sgaglione¹

2016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Biomechanical Comparison of Arthroscopic Repair Constructs for Radial Tears of the Meniscus

Abstract: Background: Radial tears of the meniscus represent a challenging clinical scenario because benign neglect and partial meniscectomy have both been shown to have negative biomechanical and long-term clinical consequences.

Cited by 47 publications

References 28 publications

Augmented repair of radial meniscus tear with biomimetic electrospun scaffold: an in vitro mechanical analysis

Augmented repair of radial meniscus tear with biomimetic electrospun scaffold: an in vitro mechanical analysis

Anterior cruciate ligament and meniscal injuries in sports: incidence, time of practice until injury, and limitations caused after trauma

Editorial Commentary: Stay Tuned: Broadening Our Scope of Knee Meniscus Radial Tear Repairs

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